In a commercial market driven by advertisements and the desire for instant gratification, patients need to be well-informed about treatments involving cosmetic dentistry. A successful case must be built on multiple foundations which include:
1. Your bite

2. Esthetic principles

3. Your personal preferences

4. The science of today's materials and techniques

The following email was sent to me from a current case in progress. This patient has done so much research on his own that he knows all the details: from the tooth numbers, to the types of porcelain available, to the characteristic tooth shapes, etc. This is an example of what every patient should know before making a decision on important restorative treatments.

This type of clear communication enables me to coordinate the work with the ceramists who also need to hear the patient's concerns and feedbacks. I am privileged to have the opportunity to work with such well-informed patients.

___________________________________________________________

Email dated Dec 18, 2010

Hi Dr. Alex

Attaches is the "style guide" from where I took the smile that I showed you today.

None of the smiles match exactly what I'm envisioning, but a few come quite close: the Hollywood/Natural/Softened styles.

* Overall: something strong and youthful, but not overly aggressive or mature

* Central incisors: I like the shape/edges on the Hollywood/Natural (actually all three look the same)

* Laterals

* I like the shape on the Hollywood (similar to my current teeth), but they could go in (up) a little more deeper on the corners, especially the edges with the centrals. Actually, the right lateral (when looking at the photo, tooth #10) on the Natural is what I'm looking for. But I don't like the shape of the left incisor (#7) on the Natural--it's too round especially on the cuspid side

* I would play with the lengths of the central and/or lateral incisor to achieve an ever so slightly larger vertical difference (maybe 0.2-0.4mm more) so it looks like the Natural. What I said in the point above about the edges going up would probably achieve the look of more difference without really changing the lengths of the teeth all that much.

* Cuspids: I like the shape of the Softened: the Hollywood is too flat, and the natural too pointed/sharp. I also think the roundness on the Softened would fit in better with the shapes of my Bicuspids

* Bicuspids: I know we only discussed bonding only on #12 for now, but my thinking is that they would end up similar to the ones seen here (they all look more or less the same in all the styles)

I understand it needs to be customized for my mouth/face shape and my bite, but wanted to share my thinking/vision on some details of the cosmetics. Let me know if you have further thoughts/questions. I know its hard to discuss some of these details through email, we can also look at the image when I come in for the next appointment, if its not too late in the process then. I can also stop by sooner if you feel that would be helpful.

Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.